Hey, I keep hearing about Medicare Advantage plans everywhere. What's the real deal with those compared to regular Medicare?

Question

Lt Col Tim Brown · Accepted Answer

There are two types of plans that go with medicare. A Medicare Supplement plan and a medicare Advantage plan. Medicare Advantage comes with dental, vision, hearing and a drug card. They are co pay driven. Example is primary care doctor no co pay, specialists (depending on the plan) you pay $15 to $50 for a visit. They come with other benefits too.

Answered by Lt Col Tim Brown on April 8, 2025

Broker Licensed in TN, AL, CO & 10 other states

Answered by Lt Col Tim Brown Medicare Insurance Agent

Gary Church · Answer

Insurance companies offering Medicare Advantage plans are paid by Medicare to manage your healthcare. As long as you're healthy, they profit. The insurance firm works with a network of doctors who agree to set prices for their services. Medicare agrees to cover care as long as it is medically necessary. Remember, with just Medicare, you're responsible for copayments and 20%.

Answered by Gary Church on July 27, 2025

Broker Licensed in Ca, AZ, NV & TX

Answered by Gary Church Medicare Insurance Agent

William Lawler · Answer

Original Medicare (OM) is a government administered 80/20 health plan. An Advantage plan covers some of the costs not covered by OM plus prescription drug, vision, dental and hearing coverage. Advantage plans are available at low or no monthly premium.

Answered by William Lawler on April 7, 2025

Broker Licensed in MO, FL, IA & 12 other states

Answered by William Lawler Medicare Insurance Agent

Christy Jones · Answer

Medicare Advantage plans are county specific and available in the county of your primary residence. Each county has different plans available. (Medicare Supplements are state specific.). There are many differences in coverage and ‘extra benefits’ like Dental/Vision/and Hearing. Original Medicare doesn’t cover those things and Medicare Advantage plans sometimes (not always) have those additional benefits.

Answered by Christy Jones on May 31, 2025

Broker Licensed in ID, AL, AR & 20 other states

Answered by Christy Jones Medicare Insurance Agent

Ben Washington · Answer

Hey, I keep hearing about Medicare Advantage plans everywhere. What's the real deal with those compared to regular Medicare? Medicare Advantage plans covers parts A and B and includes extra Dental, Vision , and Hearing , can also include prescription drug

Answered by Ben Washington on August 12, 2025

Broker Licensed in IL, FL, MN, SC, TX & WI

Answered by Ben Washington Medicare Insurance Agent

Daniel Brechin · Answer

Medicare  Advantage plans generally have no monthly premiums depending on where you live.
Regular has no limits on what you can spend in parts A&B. And have a Part D drug plan including in the program.

Tyler Coleman · Answer

Medicare Advantage plans offer additional benefits that Original Medicare doesn’t cover such as routine dental, vision, and hearing benefits. Medicare Advantage plans are legally required to cover everything Original Medicare covers, but they offer additional benefits as well.

Answered by Tyler Coleman on July 7, 2025

Broker Licensed in AL, AZ, CA & 10 other states

Answered by Tyler Coleman Medicare Insurance Agent

Marie Terhune · Answer

Medicare Advantage plans cover everything Original Medicare covers plus more - most will include Prescription Drug coverage at no additional cost (Original Medicare does NOT include part D/prescription coverage), and some will include basic dental, hearing and vision coverage and even free gym membership!

Answered by Marie Terhune on May 19, 2025

Broker Licensed in NH

Answered by Marie Terhune Medicare Insurance Agent

Justin Lucas · Answer

MAPD give you a stop loss. Depending on the plans you may receive extra stuff like Dental, Vision, Hearing.

Justin Doherty · Answer

In short, Medicare Advantage plans cover the same services as regular Medicare. However, the amount you pay for services may be higher or lower than regular Medicare. In addition, the MA plans may offer additional benefits not covered by Medicare, such as routine Dental, Vision, Hearing, and more. The way the plans operate are also different. With MA plans, you generally have a network of providers to use, while regular Medicare allows you to use any doctor that accepts Medicare. Your personal preferences on out of pocket costs vs monthly premiums will play a large roll in helping you decide which type of coverage will best meet your needs.

Answered by Justin Doherty on July 10, 2025

Broker Licensed in PA, CO, CT & 10 other states

Answered by Justin Doherty Medicare Insurance Agent

Steven Bleicher · Answer

The real deal is that if you have a low financial picture when turning age 65, the Advantage plan is right for you. The reason is that it has no monthly premium since it is subsidized by the Federal government. But the tradeoff is that each Advantage plan will contain a fairly high deductible. Each insurance firm does have the right to choose that amount at their own discretion. The importance of that is if you exhibit poor health and have to be hospitalized, the approximately $3,000.00 becomes your responsibility! Plus, every new calendar year, it starts all over again, potentially at a higher cost due to the global economy. The better choice in my professional opinion is the Medicare Supplement, if you can afford its monthly payment. Furthermore, the steep deductible does not exist with it.

Answered by Steven Bleicher on May 21, 2025

Broker Licensed in AZ

Answered by Steven Bleicher Medicare Insurance Agent

Diana Garner · Answer

Medicare Advantage plans are alternatives to Original Medicare offered by private insurance companies. They provide comprehensive coverage, often including prescription drug coverage, and even offer supplemental benefits like dental and vision. While they can be a good option for some, they also come with potential downsides like network restrictions and prior authorization requirements.

Answered by Diana Garner on May 27, 2025

Broker Licensed in KY, FL, IN, OH & TN

Answered by Diana Garner Medicare Insurance Agent

Steve Houchens · Answer

Medicare Advantage plans are an alternative to original Medicare and Medigap Plans. They couple medical and drug coverage together and many have extra benefits included which could include free gym memberships , dental, vision and hearing coverage, spendable cards with many of them having a zero premium. They are mainly an alternative and worth comparing when looking at what options best fits your personal needs.

Answered by Steve Houchens on August 3, 2025

Agent Licensed in KY & TN

Answered by Steve Houchens Medicare Insurance Agent

Barbara Barnes, CMIP® · Answer

That is a full 1+ hour discussion. Reach out and I’m happy to discuss it with you. For now, please know that they are real and they work well for some people, but you do take more medical risk with them for a variety of reasons.

Answered by Barbara Barnes, CMIP® on April 13, 2025

Agent Licensed in PA

Answered by Barbara Barnes, CMIP® Medicare Insurance Agent

Steven Lovell · Answer

Medicare Advantage replaces Medicare and you will be responsible for any and all copayments and deductibles. Also In some cases, you doctor may or may not accept your Advantage plan.

Chad Watkins · Answer

This answer is provided in a video format. Watch the agent's video response here: https://medicareagentshub.com/questions/medicare-advantage-vs-regular-medicare-real-deal#chad-watkins

Rick Boyd · Answer

Medicare Advantage plans are administered by private insurance companies. The federal government gives the private companies funds that would normally go to paying your Original Medicare insurance claims. Where as Medicare pays 80% of covered claims and the insured pays the remaining 20%, Advantage plans after a copay plus deductible, and in some cases a daily fee if involving a hospital stay for example, pay the balance of a covered service. Many Advantage plans include services that Original Medicare does not such as prescription medications, dental, vision and hearing coverage. If you choose to stay with Original Medicare, combining it with a supplement plan that covers the 20% Medicare does not, is often a good option instead of an Advantage plan.

Answered by Rick Boyd on August 5, 2025

Broker Licensed in KY, AZ, CA & OH, TN, TX & UT

Answered by Rick Boyd Medicare Insurance Agent

Don Golding · Answer

Advantage plans can be a cost-effective alternative to regular Medicare. They are private insurance companies with a Medicare contract to cover your health. Many have additional, ancillary benefits not offered in original Medicare. No plan is perfect, whether original Medicare, Medicare plus a supplemental plan (with a stand-alone drug plan), or an Advantage Care plan. All the options have benefits and drawbacks. Over 34 million beneficiaries are currently enrolled in Advantage plans. As always, I recommend a thorough review of your individual needs to find a plan that fits your unique circumstances.

Answered by Don Golding on August 4, 2025

Broker Licensed in TX, AL, AR & 5 other states

Answered by Don Golding Medicare Insurance Agent

Sharon Bohlen · Answer

Medicare Advantage plans are managed by private insurance companies who receive funds from the government to administer these healthcare plans. Medicare Advantage plans include medical, prescription drug coverage, and some dental, vision, and hearing benefits. To be eligible for an Advantage plan you must enroll in Medicare Part A and B.

Answered by Sharon Bohlen on August 21, 2025

Broker Licensed in OH, FL, IN & KY

Answered by Sharon Bohlen Medicare Insurance Agent

Fred Manas · Answer

Medicare Advantage, also known as Part C, is a private insurance option that bundles together Original Medicare (Part A and Part B) & often includes prescription drug coverage (Part D). While MA plans can offer extra benefit & lower premiums, they also have limitations like limited provider networks & restrictions on accessing care outside the service area. 
Key Differences:  Provider Networks:  Original Medicare allows you to use any doctor, while MA plans typically require you to use doctors within their network.  Extra Benefits:  MA plans often include benefits like dental, vision, & hearing coverage, which are not covered by Original Medicare. Coverage:  Both plans must cover the same medically necessary services, but MA plans may have restrictions on coverage for certain procedures or services.  Cost:  Premiums for MA plans can be lower than for Original Medicare, but out-of-pocket costs for hospital stays, surgeries, & other services may be higher. Geographic Restrictions:  Original Medicare provides coverage nationwide, while MA plans typically limit coverage to their service area. Flexibility:  It can be more difficult to switch from an MA plan back to Original Medicare compared to switching to a different MA plan.  Additional Considerations:  Cost-sharing:   MA plans often have copayments, coinsurance, & deductibles, which can vary by plan.  Extra benefits:  MA plans may offer benefits like gym memberships, transportation to appointments, & over-the-counter drug coverage.  Incentives:  Some MA plans offer incentives, such as rewards for following a care plan or using certain providers.  Restrictions on care:  MA plans may require prior authorization for certain treatments or services. MA plans offer a one-stop alternative to Original Medicare, potentially with lower premiums & extra benefits. However, they also come with limitations in provider choice, geographic coverage, & potential for higher out-of-pocket costs.  Carefully compare plans & your needs.

Gary Henderson · Answer

This is a long story, but in short, if you get a Medicare supplement plan, you have much better coverage. You're covered at 100% in the hospital. You're covered at 100% outside the hospital after you pay your annual deductible for that 
Medicare advantage plans are similar to what you had working. They look very familiar in terms of the coverage the government gives them your part b payment which this year is $185 so they offer it to you for free 
They have the same limitations that you had before with doctors, hospitals and coverages off an expensive coverages like cancer are not covered as well 
So if you can afford it, get a Medicare supplement plan. If you need assistance understanding all your options give me a call

Mike Henry · Answer

Their Dr s. Their hospitals. Everything has to be a referral. Zip code controls. May or may not cover some testing or drive a long way for one. If you have limited income might be your best option

John L Herman Jr · Answer

MEDICARE ADVANTAGE PLANS have additional coverage including DENTAL / HEARING / VISION and PDP (PRESCRIPTION DRUG PLANS). You should consult with a local Independent Boker to see which Plans and which options are available to you.

Answered by John L Herman Jr on April 16, 2025

Broker Licensed in MD, DE & PA

Answered by John L Herman Jr Medicare Insurance Agent

Tony Merwin · Answer

In short, Medicare Advantage plans are a privatized, network version of Medicare. Instead of Medicare directly handling any medical claims you have, a private insurance company will handle them. 

Medicare Advantage plans, by law, must offer at least the same benefits and coverage that Original Medicare offers, but many will offer more as a type of "all-in-one" plan whre you have one card for all services, Hospitals, Doctors, Dental, Vision, Prescriptions, etc.

Finally where Original Medicare provides access to all Medicare accepting providers nationwide, a Medicare Advantage plan will have a network of providers you must utilize to receive optimal coverage.

Kris Neupauer · Answer

The reality is that Medicare advantage plans and Medicare supplement plans need to fit the individual for their health and for their financial landscape. There is no one size fits all and I would always say an individual conversation on a case by case basis is always going to be your best option.

Answered by Kris Neupauer on May 18, 2025

Broker Licensed in MN, ND, SD & WI

Answered by Kris Neupauer Medicare Insurance Agent

Dennis Sullivan · Answer

A Medicare Advantage plan HAS to cover everything that regular or basic medicare does. The real deal is thatere is benefits outside regular medicare that you're entitled to that are offered by advantage plans.

Answered by Dennis Sullivan on July 9, 2025

Agent Licensed in FL

Answered by Dennis Sullivan Medicare Insurance Agent

Douglas Carney · Answer

To break down the buzz around Medicare Advantage (MA) plans versus Original Medicare. MA plans called "Part C" bundle Parts "A", "B", and often "D", offering extras like dental, vision, or gym memberships, and cap out-of-pocket costs. They’re budget-friendly with low or $0 premiums but limit you to provider networks and may require prior authorizations. 

Original Medicare gives you freedom to see any doctor nationwide that accepts Medicare, no approvals needed, but lacks a cost cap. To have full coverage with Original Medicare you'd have to enroll in a separate Part D and Medigap plan, which usually cost more.

Louanne Allison · Answer

Original Medicare pays 80% for your medical needs, leaving you with a 20% copay on all doctor visits, tests, and more. Medicare Advantage plans are designed to cover the 20% with specific dollar copays to the consumer. For example, a specialist may charge $300 for a visit, and if the person has just Medicare, their copay is 20% of $300 or $60. With a Medicare Advantage plan, the copay for a specialist runs between $0-$50, depending on the plan. Medicare Advantage plans often include dental, vision, hearing, free over-the-counter items, transportation and more.

Answered by Louanne Allison on April 28, 2025

Agent Licensed in MI, FL, IL & OH, TN, TX & UT

Answered by Louanne Allison Medicare Insurance Agent

Alexander Lehn · Answer

This is a hard question to answer without the opportunity to sit down with you for a presentation, but I'll give you my best breakdown. Original Medicare covers 80% of most of your healthcare costs and it carries a few different deductibles and out of pocket costs. You are required to maintain prescription drug coverage while on original Medicare and you are responsible for the 20% cost share on any approved services. Medicare does not include preventative care and requires all services to be "Medically Necessary" i.e. routine bloodwork would not be covered but if you had kidney failure and needed blood labs done, they would cover that.

In comparison, Medicare Advantage plans are more like traditional health insurance. They have a network of Doctors and Hospitals they work with and require you to use. They may have copays but they include preventative care and can offer supplemental benefits. These are the plans that people talk about which may include dental, vision, hearing, or other benefits that original Medicare doesn't. These plans can have as low as a $0 monthly premium and most of them include prescription drug coverage.

Choosing between the two requires an in-depth look at your individual health, financial situation and lifestyle preferences. If you travel a lot, staying on original Medicare and purchasing a Supplement plan may be best for the flexibility of no mandated network. If you stay close to home and prefer having some supplemental benefits or are lower income and need a $0 monthly premium, the Advantage plan may be a great option. It comes down to talking with a licensed agent who can understand your needs to provide the right options so you can make an informed decision.

Robert Evans · Answer

Regular Medicare covers hospitalizations and doctor visits. A Medicare Advantage plan order the same but also offer more benefits. Dependent on the Medicare advantage plan it will cover your prescription drug plan which regular Medicare does not cover. Also a Medicare advantage plan can offer gym memberships and a set rate for other services such as skilled nursing facilities hospitalization stays lab work and a host of preventive services. Suggest you speak with an agent to compare different plans and see which ones provide benefits that are suited for you.

Answered by Robert Evans on June 7, 2025

Agent Licensed in TX

Answered by Robert Evans Medicare Insurance Agent

Angel Feliciano · Answer

Medicare Advantage plans, also known as Medicare Part C, are an alternative to Original Medicare (Part A and Part B). Here’s a breakdown to help you understand the key differences and benefits:

1. **Coverage**:
   - **Original Medicare**: Provides hospital insurance (Part A) and medical insurance (Part B). It covers a wide range of services but does not include many additional benefits.
   - **Medicare Advantage**: These plans include all the benefits of Original Medicare and often offer additional coverage, such as dental, vision, hearing, and wellness programs. Some plans may also include prescription drug coverage (Part D).

2. **Provider Networks**:
   - **Original Medicare**: Allows you to see any doctor or specialist who accepts Medicare, giving you more flexibility.
   - **Medicare Advantage**: Typically has a network of providers. If you choose a plan with a Health Maintenance Organization (HMO) structure, you may need to use doctors within that network, and referrals may be required to see specialists.

3. **Costs**:
   - **Original Medicare**: You pay premiums for Part B, and there are deductibles and coinsurance for services. There’s no cap on out-of-pocket costs.
   - **Medicare Advantage**: Usually has lower monthly premiums, but you might have copayments for specific services. Many plans have a maximum out-of-pocket limit, which provides financial protection.

4. **Enrollment**:
   - **Original Medicare**: Enrollment is typically automatic if you are collecting Social Security benefits when you turn 65.
   - **Medicare Advantage**: You need to enroll in a specific plan during the Open Enrollment Period (October 15 to December 7) or during Special Enrollment Periods if you qualify.

5. **Flexibility**:
   - **Original Medicare**: Offers the flexibility to see any provider who accepts Medicare.
   - **Medicare Advantage**: While it offers additional benefits, you may have less flexibility due to provider networks.

6. **Prescription Drug Coverage**:

Stephen Garrard · Answer

Original Medicare will cover 80% of covered charges, leaving the beneficiary to pay the other 20%. To help with that 20% out of pocket amount, the two solutions are referred to as "Medicare Advantage" plans and "Medigap" (Medicare Supplement) plans. 

Advantage plans cover everything but copays or coinsurance for services used (fee-for-service model) and will typically not charge a monthly premium. Many times an Advantage plan will include Part D prescription drug (Rx) benefits at no additional premium and can even offer cheaper Rx copays than a stand-alone Rx plan. In addition, Advantage plans can include extra benefits not covered by Medicare, such as dental, vision, hearing, gym membership, and other benefits. 

Medigap (Supplement) plans cover the majority, if not all, of your out of pocket medical expense, but charge a substantial monthly premium regardless of how often you use medical services. In addition, Medigap does NOT cover Rx medications, so you are required to enroll in a separate Rx drug plan which will likely also include an additional separate premium. Medigap plans do not offer additional benefits. 

Typically I only recommend Medigap for someone who has a complex medical history and risks spending more on an Advantage plan's Maximum Out Of Pocket limit (MOOP) than it would cost to pay the annual premium on the Medigap supplement plan. (MOOP is a safety net with Advantage Plans that prevent you from any catastrophic expenses). Another reason would be to accommodate extenuating provider network access issues. Some people prefer Medigap over Advantage plans because they might have enough financial cushion to not factor premiums into their decision. They simply want the psychological safety of knowing everything is paid for without having to reconcile copays or medical bills.

In my view, it's easy to see why Medicare Advantage plans have become so popular. Who wouldn't want more for less?

Taylor Blankenship · Answer

Regular or “Original Medicare” only cover part A- Hospital and part B-Medical 
Usually with Original Medicare you have to add on a drug plan and that means you will have a few different premiums. Original Medicare also does not include an Out Of Pocket Maximum… So you take on a bunch of risk if you was to ever have an extended stay or a high Hospital bill. 

Medicare Advantage plans make things a lot simpler, like combining your Hospital, Medical and Drug coverage all in one. With one premium payment, some Medicare Advantage plans also have a $0.00 premium and these plans usually have built in perks like Dental, Silver Sneakers/ Gym membership, Over the counter benefits and more. Plus there are a ton of plans to choose from with all different and trusted carriers, make sure you have an agent that can go over the details of the plan and make sure your doctors and medications are covered.

Todd Poe · Answer

Medicare Advantage has lower out of pocket maximum
Can include dental, vision, hearing and other benefits that Orig Medicare does NOT have
Typically Medicare Advantage can save you money on precriptions.  Original Medicare does NOT cover medications.